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More on the ‘Twiblings’

By Lisa Belkin January 3, 2011 12:08 pmJanuary 3, 2011 12:08 pm

Fourteen years ago, when I first wrote on the subject of egg donation for The New York Times Magazine, I visited a woman who was one of the first “brokers” in the country to match donors and prospective parents. We sat in her sunny California garden (all new things start in L.A.) and paged through books of donor profiles — complete with their health histories, lists of likes and dislikes and smiling photos of themselves and, often, their children.

I was taken aback. “How can these women do this knowing that a child — their child — will be out in the world without them?” I asked. I will never forget her answer.

“There are two kinds of women. Those who think of this as giving up a child, and those who don’t. You could never be a donor.”

When it comes to questions of reproduction and adoption and surrogacy and technology, there always seem to be two distinct sides — those who can’t imagine doing “that,” and those who can’t imagine not.

Many of you have asked why The Times ran Melanie Thernstrom’s article this weekend since it was, you said, about so specific and privileged a couple. My answer would be (though I don’t claim to speak for The Times) that hers is, despite its details, a universal story. Just look at the comments. The questions of what makes a parent, and how far to take modern science, and what our dreams are for our children, and what our responsibilities are, are asked but not answered by tales like these. That’s because there are no answers. Or at least there is no ONE answer.

Thernstrom has read every single one of your comments and would like to reply to some of them. She wants to clear up some facts and answer some questions. She’s not here to debate or change your minds, because, as I learned all those years ago, and she relearned this weekend, on this subject we don’t decide with our minds but with our guts. And guts are much slower to change.

From Melanie Thernstrom:

The topic of third-party reproduction is a lightning rod for many readers. It is clearly a topic in need of public discussion.

Several questions have come up in the forum postings that I thought it would be helpful to address.

1. A number of readers wonder why we didn’t “just adopt” a minority baby. Since one of Michael’s wonderful sisters is African-American, we were well aware that a family does not need to look alike to be united through the bonds of love, and we specifically explored interracial adoption. What we learned is that the situation is quite different from when she was adopted nearly four decades ago. Most minority birth mothers prefer to place their babies with couples who share their race and thus choose such couples when they are involved in placing the baby. Also, a number of professional social-work organizations take the position that it is better for minority children to be placed in minority or mixed-race households. White couples in their 40s (with medical strikes against them) do not top anyone’s list. We’ve all seen the pictures of Sandra Bullock with her adorable son — but she waited four years to get him.

The intense competition for babies to adopt is a result of the fact that fewer women are giving up babies for adoption. Fewer unwanted pregnancies is clearly a positive social development, but a result is that an increasing number of infertile couples will need to look at alternatives to adoption. When Michael and I considered adoption, we asked ourselves what anyone would: how would we feel if we spent years pursuing an adoption and ended up childless — which is what happened to friends of ours? We also explored foreign adoption, particularly in China, because China is hospitable to older parents, but we discovered we didn’t meet other requirements. In mentioning some of the challenges of adoption, I do not mean to discourage anyone from pursuing it; it has been a tremendous blessing for Michael’s family and for other of our friends who were lucky to find their children that way.

2. Other readers wondered why we didn’t adopt an older child through the foster-care system, a point I did not address in my article. It is absolutely true that the country is in need of foster-care homes for children who are sometimes available for adoption. But having worked in a reform school for teenagers in the foster-care system, as well as having family members who have adopted older children through the foster-care system, I am extremely familiar with the challenges and the special skills it takes to meet them, and we did not feel it was the right path for us. But it is certainly a commendable path for any family to take — whether fertile or infertile.

3. Several readers express the belief that surrogacy is “rich women exploiting lower-class women.” The notion of surrogates as lower-class women relies on a faulty stereotype and is offensive to surrogates in several ways. Many surrogates, like Melissa and Fie, are middle-class professional women with families who want to help someone experience the joy that they take in their own children. Surrogates, regardless of their income and occupation, are proud of what they do and of the happiness they help bring into the world — you have only to read postings on Web sites like surromomsonline.com to see how true this is. To insist they are being exploited is to discount their own will and their self-reported feelings about the process. Melissa’s and Fie’s perspectives on their experience can be heard in the audio interviews on the Web site (and Melissa has posted here in the comments).

4. Many readers expressed the belief that in order to use a third-party reproduction, you have to be “ultrawealthy.” It is important to understand that while surrogacy is usually expensive, many couples turn to egg donation because they cannot afford adoption (typically $20,000 to $35,000). The most common cause of infertility for women in their 40s is poor egg quality, rather than problems carrying a baby through pregnancy. For many of them, infertility problems can be solved with egg donation. Although there are some high-cost donors, the average donor fee is about $5,000, plus medical expenses for the cycle (which vary, but are typically around $12,000). Some insurance covers I.V.F. treatment, or part of the cost; states like Massachusetts and Connecticut actually have legal mandates that require such coverage. For couples with coverage who get egg donation from a friend or relative or a low-fee donor, the cost can be significantly lower than adoption.

5. Surrogacy is generally much more expensive (estimates vary greatly, but the reported average seems to be about $60,000). There are surrogates who do so altruistically for little or no compensation, as in the inspiring story that Laura (Comment No. 253) shares of how her “twiblings” came to be, using an egg donor and two separate colleagues who volunteered to carry her children.

6. A number of readers complained that I didn’t list the specific financial arrangements we had with Melissa, Fie or the Fairy Goddonor. Those arrangements are private to them, and that confidentiality is guaranteed in their contracts.

7. Some readers wonder why we chose “gestational carriers” (the medical term for surrogates who do not use their own eggs) rather than traditional surrogates (who do). Traditional surrogacy is less expensive than using both an egg donor and a gestational carrier, and some couples still do it. Most fertility clinics, however, recommend using a gestational carrier in order to make it less emotionally complicated for the carrier and their families. Neither Melissa nor Fie was interested in being a traditional surrogate: although Melissa had been an egg donor before, she did not want to carry a child who was a half-biological sibling to her children. One reader advocates her belief that traditional surrogacy is better because the women take less medication. As a person who did six rounds of I.V.F., I researched the medication extensively and was comfortable with its safety profile, as were the other three women involved.

8. A number of readers concluded from the fact that I write about our nanny that we aren’t “raising our own children.” Although Michael and I have been lucky to arrange our work schedules to work part time, there are times when we both need to work, and in the absence of nearby relatives we are grateful to have found caring people to help our family. As I say in the article, we also believe that many loving adults can have a hand in helping a child grow.

9. Several readers wondered if I chose the title (“My Futuristic Insta-Family”) or subtitle (particularly the use of the word “conspire”) or the photos. I did not.

10. Many readers expressed the sense that it is not fair that we got to solve our infertility in a way that many infertile couples will not be able to afford. This is clearly a complicated issue. Many of our fellow citizens do not have consistent access to health care; we live in a country in which the social safety net leaves many more people to fall through the holes than happens in other rich countries. This is a subject I have strong feelings about, but it’s a much larger story — and I don’t agree with the argument that an individual should forgo medical treatment because of these inequities. In Scandinavia, incidentally, 10 percent of the population is born through I.V.F. (about the same as the proportion of the population that is infertile), the costs of which are entirely covered by the state (and they spend a significantly smaller fraction of their G.D.P. on health care than we do).

I wish all those suffering from infertility strength, courage, and luck in their journey to find a path that works for them.

Correction From Melanie Thernstrom: While estimates vary, the percentage of babies born through IVF in Scandinavia actually seems to be between 2 to 4%. IVF and similar technologies have been reported to contribute to 2 to 5 percent of the new births in more than a dozen European nations. When (in response to readers comments) I checked my original source, it turned out that I had mis-recollected what the author had said. In fact, he wrote that countries where the state pays for IVF may someday see the percentage approach the percentage of the population which is infertile, which is roughly 10%.

I would also like to note that most of these countries have age limits in eligibility. While the bioethics of whether age-related infertility can be debated, I do not believe there is ethical justification for infertility not being covered in people of childbearing age. Not to do so creates the untenable situation in which infertility is a treatable disease–but only for those who can afford it.

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We're all living the family dynamic, as parents, as children, as siblings, uncles and aunts. At Motherlode, lead writer and editor KJ Dell’Antonia invites contributors and commenters to explore how our families affect our lives, and how the news affects our families—and all families. Join us to talk about education, child care, mealtime, sports, technology, the work-family balance and much more